Change to Electronic Data Interchange

On July 16, 2023, ForwardHealth will implement a new component for its claims processing system. The Electronic Data Interchange as a Service (EDIaaS) Translator will help ForwardHealth better adhere to established Electronic Data Interchange (EDI) standards and better align with other states and payers. ForwardHealth uses EDI standards to verify the format of health care-related information (for example, claims, payments, and eligibility) when it is shared between trading partners and ForwardHealth.

After implementation, the new EDIaaS Translator will reject for X12 non-compliance errors that were previously not monitored. Based on the ASC X12N EDI Implementation Guides for version 005010, following are common data errors that will result in rejection of EDI X12 transactions submitted to ForwardHealth:

• The Interchange Receiver ID (ISA-08) is not WISC_DHFS.
• Leading zeros appear in the Functional Group Control Number (GS-06).
• The transaction control number (ST-02 and SE-02) is not unique within a Functional Group.
• A “P.O. Box” reference appears in the billing provider address field. This includes addresses submitted with a street address followed by a P.O. Box (Loop 2010AA, Element N3-02).
• Spaces or dashes (-) appear in the N4-03 element when sending a nine-digit zip code.
• A Subscriber ID Number does not have the value “MI” as the qualifier (Loop 2010BA, Element NM1-08). The value “II” will be rejected.
• The Group Name (SBR-04) is included when Group or Policy Number (SBR-03) is sent in Loop 2320, Other Subscriber Information (SBR) segment.
• The Adjustment Amount (CAS-03) equals zero when submitting an Adjustment Segment (CAS) at the Claim (Loop 2320) or Service Line (Loop 2430) level.
• Both a National Provider Identifier (NPI) and a REF*G2 (atypical provider ID) are sent. If an NPI is available, use it.

Apart from rejections for common data errors, trading partners should not be impacted by the implementation. There will be no change to the current process of sending and receiving files. However, trading partners are advised to verify proper transaction processing following the implementation. If improper transactions are discovered, trading partners are encouraged to contact the EDI Help Desk using one of the methods listed in this email.

No changes are being made to Provider Electronic Solutions (PES).

Non-Production Support Schedule Change

The EDI non-production (test) support schedule will change with this migration. Effective July 17, 2023, EDI non-production availability will be Monday through Friday, 6 a.m.-8 p.m. Central Time.

For More Information

Contact the EDI Help Desk at 866-416-4979 or VEDSWIEDI@wisconsin.gov for questions about these changes.